Often the problem with the upper lid is ROOF which is fat that sits just behind the muscle. If this is not removed the fullness persists

Lower lid blepharoplasty

The cheek lift is more obvious here

Upper and lower lid blepharoplasty

The lower lid opens the eye up a bit

Upper lid blepharoplasty

Again the upper lid is ROOF which is fat that sits just behind the muscle has been removed.

Upper and lower lid blepharoplasty

Not just skin removal but also removal of moving of the fat causing the puffy bags below the eye and the fullness in the upper eyelid

Blepharoplasty FAQs

Different Types of Blepharoplasty Surgery

Upper Lid Blepharoplasty– The operation involves removing a crescent of skin from the eyelid with some of the muscle and if necessary removing fat from the two pockets of fat behind the upper eyelid. Fat in the eyelid itself (ROOF) which can cause heaviness of the eyelid can also be removed

Lower Lid Blepharoplasty– In most cases the operation site is just below the lower eyelashes and onto the cheek at the outer corner of the eye. The excess skin and fat from the three pockets are removed and the corner of the eyelid lifted slightly to improve appearance.

4 Lid Blepharoplasty– This is as above the combined procedure takes about 1 ½ hours.

Blepharoplasty Operation and hospital stay

Upper or lower blepharoplasty operations take about 1 hour, with 4 lids taking about 1 ½ hours. It is best done under a General Anaesthetic, although it can be performed under Local Anaesthetic injections. If it is done under Local Anaesthetic there is a risk that people find it unpleasant.

What can go wrong with Blepharoplasty

It is important when considering surgery to understand that all operations have risks and blepharoplasty is no exception.

All eyelid operations have a risk of (in order that they may occur):
• Bleeding: this may lead to more extensive bruising and swelling, but is unlikely to affect the final result. It is uncommon. There is a very remote possibility that the bleeding may require a return to the operating theatre.
• Infection: there is a very small risk of wound infection which would be expected to respond readily to antibiotics. The eyes may be irritated and weepy for a while, but the ointment that you go home with normally prevents this.
• Opening of the wound line: This is uncommon. If it is a small area it will probably heal without treatment without causing any ill effect on the result. If a more significant part of the wound has opened this may require repairing under some local anaesthetic. Again the final result should be unaffected.
• Double vision: This affects lower eyelid surgery and again is very rare and in the vast majority of cases resolves in a few days without treatment. An ophthalmic specialist review would be provided.
• Loss of vision: The risk of this is quoted as 1 case in 50,000 and it has not been reported in the UK amongst plastic surgeons for a very long time, but it must be mentioned before the operation.
• Dry eyes: this is reasonably common and due to swelling, (about 1 in 10 cases) but settles in time and may require the use of artificial tears for a while until the swelling settles.
• Watery eyes: again this is due to swelling and is reasonably common, but settles quickly.
• Pigment change in the lower lid: this is rare and normally associated with high levels of bruising. It normally resolves without treatment, but can be treated if persistent.
• Poor scars: this is very rare although it is not uncommon for the scars to become slightly more visible for a while around the 6 -10 week mark. Treatment is available if this is troublesome.
• Asymmetry, lower lid retraction (pulling down away from the eye) and hollow eyelids are all consequences of surgical technique and are rare and mostly correctable.
• As this is a surgical procedure to deal with appearance no guarantee can be given to the final appearance, but if we agree it is an unsatisfactory result correction will be offered at no additional cost.
• All operations can result in long term discomfort.
• All operations have a small risk of Deep Vein Thrombosis (DVT), chest infection and Pulmonary embolism. Death following elective surgery is exceptionally rare (1:250,000 in fit and well people)

The majority of people who undergo eyelid surgery are very pleased with the result and feel it makes a very positive change to their appearance.

After Blepharoplasty

For both upper and lower lids, the eyelid is repaired using a fine suture and some adhesive strips which remain for 5 to 7 days.

You will have eye ointment in to protect your eyes for a few days during the day and at night for two weeks. Cool packs will be applied over the eyes in recovery to help reduce bruising and swelling. You will be given two cool packs to wear at home and these should be worn as much as possible while the swelling persists one pack should be worn until it warms up and the other kept in the fridge until needed.

Everyone who has eyelid surgery is kept in hospital overnight for observation. Expect some bruising and swelling which takes about 4 weeks to settle down.

A one week follow-up will be given to make sure everything is OK and take the stitches out. I will personally see you at 1, 4 and 12 weeks and 6 and 12 months following surgery and more if required. Make-up should wait until the stitches are removed.

High factor sun block and general sun protection is needed for the next 12 months after surgery when out on days where sun exposure is likely. Failure to do this can result in permanent and unpleasant pigment changes.

What to expect from Blepharoplasty

Eyelid surgery makes an immediate and dramatic difference, although it may take around 2 weeks for the bruising to settle and 4 weeks for the swelling to be nearly gone. There may be some discomfort for a few days and antibiotic eye ointment is used to protect the eyes in the first few days as closing the eye easily can take around two weeks. Normally 4-6 weeks after the surgery, there is very little swelling or evidence of recent surgery. It may even be quicker than this. Between 8 and 12 weeks the scar may become a little pink this is normal and can be covered with makeup if it is a problem. The scars should settle to form fine, pale flat scars. By 12 weeks the final result in terms of skin settling is achieved.

Cost of Blepharoplasty Surgery

– from £3200 for upper blepharoplasty
– from £4710 for upper and lower blepharoplasty (4 lids)
This includes all required follow-ups and in the unlikely event you require further treatment due to post-operative problems any further treatment is also included

(prices updated Feb 2018)

Post Operative instructions for Blepharoplasty

What to bring to hospital

If you would like, bring a family member or friend. Bring some easy to put on bed wear, preferably with front buttons and your own clothes and toiletries and something to pass the time like books, puzzles or some music . The rooms have televisions and there is free Wi-fi.

What to look out for after you have gone home

Before you come into hospital, you will get a package that contains a set of post-operative instructions and a thermometer.

Watch out for redness, swelling, pain, discharge, opening of the wound, fevers, sweating and shaking. Whatch to see if your temperature is above 37.2C and you feel unwell or it is above 37.6C.

If any of the above are seen or any of the information of the instruction sheet call the numbers on the instruction sheet or the hospital you had your operation.

Most fruit and pickles have aspirin like chemicals in them so avoid large quantities in the two weeks before surgery.

Please remember that if you have any questions or concerns to ask during one of your consultations. Writing questions down is sometimes helpful.

Driving

Normally you can re-start driving at around 2 weeks. You are fit to drive if you feel you are fit. I recommend you have someone take you to an industrial zone or supermarket car park late at night so you can attempt driving without risk to others. If you find you can drive without problems you are safe to go out on the road

Work

Depending on how physical the work you do is, you can start working from between 1 and 3 weeks.

If in doubt remember you can always ask for advice.

Exercise

At home rest is necessary for one week and any strenuous activity, bending, and lifting etc. is to be avoided. You can shower once your dressings are reduced after your first appointment.

Physical exercise more than a gentle walk should be avoided for the first least 3 weeks and then only undertaken if comfortable. After 3 weeks I allow swimming and cycling and more vigorous walking. After 6 weeks you can, if it is comfortable, return to full activities.